Fuhrman G M, Charnsangavej C, Abbruzzese J L, Cleary K R, Martin R G, Fenoglio C J, Evans D B
Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Am J Surg. 1994 Jan;167(1):104-11; discussion 111-3. doi: 10.1016/0002-9610(94)90060-4.
A prospective diagnostic study was designed to determine the ability of thin-section contrast-enhanced computed tomography (CT) to predict the resectability of malignant neoplasms of the pancreatic head. Patients with a presumed resectable pancreatic neoplasm referred during a 21-month period were studied with abdominal CT performed at 1.5-mm section thickness and 5-mm slice interval during the bolus phase of intravenous contrast enhancement. CT criteria for resectability included the absence of extrapancreatic disease, no evidence of arterial encasement, and a patent superior mesenteric-portal venous confluence. Of 145 patients evaluated, 42 were considered to have resectable tumors by CT criteria, and 37 (88%) underwent potentially curative pancreaticoduodenectomy. Six patients were found to have a microscopically positive retroperitoneal resection margin; no patient had a grossly positive resection margin. Five (12%) of 42 patients were found at laparotomy to have unresectable, locally advanced or metastatic tumors. Thin-section contrast-enhanced CT is an essential component of the preoperative evaluation for pancreaticoduodenectomy and can prevent needles laparotomy in most patients with locally advanced or metastatic disease.
一项前瞻性诊断研究旨在确定薄层增强计算机断层扫描（CT）预测胰头恶性肿瘤可切除性的能力。对在21个月期间转诊的疑似可切除胰腺肿瘤患者进行了研究，在静脉注射造影剂的团注期，以1.5毫米的层厚和5毫米的层间距进行腹部CT检查。可切除性的CT标准包括无胰腺外疾病、无动脉包绕证据以及肠系膜上静脉-门静脉汇合处通畅。在145例接受评估的患者中，42例根据CT标准被认为患有可切除肿瘤，其中37例（88%）接受了可能治愈性的胰十二指肠切除术。6例患者的显微镜下腹膜后切缘阳性；无患者肉眼切缘阳性。42例患者中有5例（12%）在剖腹手术中被发现患有不可切除的局部晚期或转移性肿瘤。薄层增强CT是胰十二指肠切除术术前评估的重要组成部分，可在大多数局部晚期或转移性疾病患者中避免剖腹探查。
